Author Information

Background

There is today no clinical published data about the potential increased bleeding risk due to interaction between dronedarone and NOACs. Although there is no recommendation against co-treatment with apixaban, the potential interaction has raised concerns among physicians. The aim was to study major bleedings in AF patients treated with dronedarone and either apixaban or warfarin.

Methods

Retrospective registry study using population wide Swedish health care registries. All patients with a diagnosis of nonvalvular AF between May 29, 2013 (when apixaban was introduced in Sweden) and December 31, 2015 and with concomitant treatmetn with either dronedarone-apixaban (n=1,423) or dronedarone-warfarin (n=3,010) were identified. Propensity score matching was used to create two similar cohorts each of 521 patients.

Results

In the propensity score matched cohorts, 6 patients on apixaban and 12 patients on warfarin suffered a major bleed leading to hospitlization or death. Corresponding rates were 1.3 and 1.7 per 100 years at risk respectively. No statistical significant difference in bleedings were seen between the cohorts.

Conclusion

The incidence of bleedings was very low in both cohorts and no significant differences were found between the regimes. There is nothing to indicate that co-treatment with apixaban and dronedarone should cause more bleeds that co-treatment with warfarin and apixaban.

The inability to prevent file sharing has led the recording and movie industries to devise sophisticated copy protection on their s and s. In a particularly controversial incident,
Sony Corporation
introduced CDs into the market in 2005 with copy protection that involved a special viruslike code that hid on a user’s computer. This code, however, also was open to being exploited by virus writers to gain control of users’ machines.

The majority of academic journals are now online and searchable. This has created a revolution in
scholarly publishing
, especially in the sciences and engineering. For example, arXiv.org has transformed the rate at which
scientists
publish and react to new theories and experimental data. Begun in 1991, arXiv.org is an online archive in which physicists, mathematicians, computer scientists, and computational biologists upload research papers long before they will appear in a print journal. The articles are then open to the scrutiny of the entire scientific community, rather than to one or two referees selected by a journal editor. In this way scientists around the world can receive an abstract of a paper as soon as it has been uploaded into the depository. If the abstract
piques
a reader’s interest, the entire paper can be downloaded for study. Cornell University in Ithaca, New York, and the U.S.
National Science Foundation
support arXiv.org as an international resource.

While arXiv.org deals with articles that might ultimately appear in print, it is also part of a larger shift in the nature of scientific publishing. In the print world a handful of companies control the publication of the most scientific journals, and the price of institutional subscriptions is frequently exorbitant. This has led to a growing movement to create online-only journals that are accessible for free to the entire public—a public that often supports the original research with its taxes. For example, the Public Library of Science publishes online journals of biology and medicine that compete with traditional print journals. There is no difference in how their articles are vetted for publication; the difference is that the material is made available for free. Unlike other creators of content, academics are not paid for what they publish in scholarly journals, nor are those who review the articles. Journal publishers, on the other hand, have long received subsidies from the scientific community, even while charging that community high prices for its own work. Although some commercial journals have reputations that can advance the careers of those who publish in them, the U.S. government has taken the side of the “
open source
” publishers and demanded that government-financed research be made available to taxpayers as soon as it has been published.